Emergency Department Initiated Palliative Care Consultation in a Rural Setting

ObjectivePalliative care (PC) consults in the emergency department (ED) have the potential to impact patient care earlier than inpatient consults, including disposition from the ED, advanced care planning and changes in code status, hospital and intensive care unit (ICU) length of stays (LOS), and hospice enrollment. Most prior studies examined ED PC consults in urban settings. This study compares PC consults in the ED with a part time ED embedded PC physician to consults after admission in a center with a largely rural catchment area.MethodsThe medical records of 150 patients who had ED PC consultation were compared to 150 randomly selected patients with inpatient PC consultation over the same timeframe. Data collected included disposition from the ED and/or hospital, hospital LOS, ICU days, completion of advance care planning, code status changes, and the presence of a prior cancer or PC diagnosis or previous PC involvement.ResultsOverall, 28 (18.7%) patients who had PC consults in the ED were discharged, and those who were admitted were significantly (P < .05) less likely to be admitted to the ICU and had shorter ICU and hospital LOS. Significantly more patients had advanced care planning documented after ED consultation than after inpatient consultation (94.7% vs 87.3%, respectively). Both groups had high rates of code status changes.ConclusionPatients seen by a PC consultant in the ED in a rural healthcare setting had shorter hospital stays, were less likely to be admitted to the ICU, and fewer days in the ICU.